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In the early results on the safety of SCH 530348, the first oral thrombin receptor antagonist, there was a slight but not statistically significant increase in major and minor bleeding events -- 4% versus 3.3% for placebo -- with a 40-mg dose. In further trials, 40 mg is the investigational dose that is expected to be pursued."

Saturday, March 24, 2007

Acute coronary syndrome (ACS)8 refers to a constellation of clinical symptoms caused by acute myocardial ischemia1,2. Owing to their higher risk for cardiac death or ischemic complications, patients with ACS must be identified among the estimated 8 million patients with nontraumaticchest symptoms presenting for emergency evaluation each year in the US3. In practice, the terms suspected or possible ACS are often used by medical personnel early in the process of evaluation to describe patients for whom the symptom complex is consistent with ACS but the diagnosis has not yet been conclusively established./.../

Wednesday, March 21, 2007

Abstract--Despite compliance with lifestyle recommendations, some children and adolescents with high-risk hyperlipidemia will require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia. The purpose of this statement is to examine new evidence on the association of lipid abnormalities with early atherosclerosis, discuss challenges with previous guidelines, and highlight results of clinical trials with statin therapy in children and adolescents with familial hypercholesterolemia or severe hypercholesterolemia. Recommendations are provided to guide decision-making with regard to patient selection, initiation, monitoring, and maintenance of drug therapy

Monday, March 19, 2007

Worldwide, cardiovascular disease (CVD) is the largest singlecause of death among women, accounting for one third of alldeaths.1 In many countries, including the United States, morewomen than men die every year of CVD, a fact largely unknownby physicians.2,3 The public health impact of CVD in women isnot related solely to the mortality rate, given that advancesin science and medicine allow many women to survive heart disease.For example, in the United States, 38.2 million women (34%)are living with CVD, and the population at risk is even larger.2In China, a country with a population of approximately 1.3 billion,the age-standardized prevalence rates of dyslipidemia and hypertensionin women 35 to 74 years of age are 53% and 25%, respectively,which underscores the enormity of CVD as a global health issueand the need for prevention of risk factors in the first place.4As life expectancy continues to increase and economies becomemore industrialized, the burden of CVD on women and the globaleconomy will continue to increase.5 The human toll and economic impact of CVD are difficult to overstate.In the United States alone, $403 billion was estimated to bespent in 2006 on health care or in lost productivity as a resultof CVD, compared with $190 billion for cancer and $29 billionfor human immunodeficiency virus (HIV).2 In addition to population-basedand macroeconomic interventions, interventions in individualpatients are key to reducing the incidence of CVD globally.6Prevention of CVD is paramount to the health of every womanand every nation. Even modest control could have an enormousimpact. It is projected that a reduction in the death rate dueto chronic diseases by just 2% over 1 decade would prevent 36million deaths.6

Sunday, March 11, 2007

[Original Article]Coogan, Patricia F.*; Rosenberg, Lynn*; Strom, Brian L.†‡From the *Slone Epidemiology Center, Boston University, Boston, Massachusetts; †Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Center for Education and Research on Therapeutics, and ‡Division of General Internal Medicine of the Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.Submitted 16 May 2006; accepted 13 November 2006.Supported by grant R01 CA45762 from the National Cancer Institute.Editors’ note: A commentary on this article appears on page 194.Correspondence: Patricia F. Coogan, Slone Epidemiology Center, 1010 Commonwealth Ave., Boston, MA 02215. E-mail: pcoogan@bu.eduAbstractBackground: Statins affect the proliferation, survival, and migration of cancer cells, and it is thought that they may have chemopreventive properties in humans. The purpose of the present study was to evaluate the association between statin use and various types of cancer in our hospital-based case–control surveillance study.Methods: Data were collected from patients ages 40–79 years who were admitted to participating hospitals in 3 centers in Philadelphia, New York, and Baltimore from 1991 to 2005. Nurses administered questionnaires to obtain information on medication use and other factors. We compared patients who had any of 10 types of cancer (a total of 4913 patients) with controls admitted for noncancer diagnoses (3900 patients). The following cancers were examined individually: female breast (n = 1185), prostate (n = 1226), colorectal (n = 734), lung (n = 464), bladder (n = 240), leukemia (n = 254), pancreas (n = 220), kidney (n = 226), endometrial (n = 220), and non-Hodgkin lymphoma (n = 144). Logistic regression models were used to estimate odds ratios and 95% confidence intervals among regular statin users compared with never-users.Results: Odds ratios were compatible with 1.0 for all cancer types. For the 4 largest cancer sites (breast, prostate, colorectum, and lung), odds ratios did not vary significantly by duration of statin use.Conclusions: Statins are among the most commonly used medications, and durations of use are increasing. The present data do not support either positive or negative associations between statin use and the occurrence of 10 cancer types. Cancer incidence should continue to be monitored among statin users.

Review of the American Heart Association’s guidelines for cardiovascular disease prevention in women

Cardiovascular disease (CVD) is the leading cause of death ofwomen in the United States and most of the developed world.The latest available data from the World Health Organizationindicate that 16.6 million people around the globe die of CVDeach year. World deaths from coronary heart disease (CHD) in2002 totalled 7.2 million. One in seven women in Europe willdie of CHD; in the United Kingdom > 1.2 million women areliving with CHD. Despite advances in diagnosing and treatingCHD, the disease accounts for the majority of CVD deaths inwomen in the United States, with more than 240 000 dying annually.Although coronary heart disease is the predominant cause ofmortality for adult women in the United States, screening forcoronary risk factors and coronary risk reduction interventionsremains underused in women. In February of 2004, the AmericanHeart Association published the first evidence-based guidelinesfor CVD prevention in women, consisting of a set of clinicalrecommendations tailored to a woman’s individual levelof risk.

Using data from the first federal National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, the researchers found that survey participants 65 or more years old with higher caffeinated beverage intake exhibited lower relative risk of coronary vascular disease and heart mortality than did participants with lower caffeinated beverage intake.

John Kassotis, MD, associate professor of medicine at SUNY Downstate, said, "The protection against death from heart disease in the elderly afforded by caffeine is likely due to caffeine's enhancement of blood pressure."

The protective effect also was found to be dose-responsive: the higher the caffeine intake the stronger the protection. The protective effect was found only in participants who were not severely hypertensive. No significant protective effect was in patients below the age of 65.

No protective effect was found against cerebrovascular disease mortality - death from stroke - regardless of age.